From the abstract:
Objectives.
To identify occupations with high-priority workforce development needs at public health departments in the United States.

Methods.
We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed.

Results.
Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees.

Conclusions.
Strategies for addressing workforce development concerns of health agencies include providing additional training and workforce development resources, and identifying best practices for recruitment and retention of qualified candidates.

From the abstract:
Objectives.
To identify payments that involved opioid products from the pharmaceutical industry to physicians.

Methods.
We used the Open Payments program database from the Centers for Medicare and Medicaid Services to identify payments involving an opioid to physicians between August 2013 and December 2015. We used medians, interquartile ranges, and ranges as a result of heavily skewed distributions to examine payments according to opioid product, abuse-deterrent formulation, nature of payment, state, and physician specialty.

Results.
During the study, 375 266 nonresearch opioid-related payments were made to 68 177 physicians, totaling $46 158 388. The top 1% of physicians received 82.5% of total payments in dollars. Abuse-deterrent formulations constituted 20.3% of total payments, and buprenorphine marketed for addiction treatment constituted 9.9%. Most payments were for speaking fees or honoraria (63.2% of all dollars), whereas food and beverage payments were the most frequent (93.9% of all payments). Physicians specializing in anesthesiology received the most in total annual payments (median = $50; interquartile range = $16–$151).

Conclusions.
Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. These findings should prompt an examination of industry influences on opioid prescribing.

From the abstract:
Issue: A draft Better Care Reconciliation Act (BCRA) has been introduced in the U.S. Senate as an alternative to the American Health Care Act (AHCA), which was passed by the House of Representatives on May 4, 2017. The Congressional Budget Office estimates the BCRA would raise the number of uninsured by 22 million by 2026.

Goal: To determine the consequences of the draft BCRA on employment and economic activity in every state. This report updates an earlier analysis of the effects of the AHCA.

Methods: We compute changes in federal spending and revenue from 2018 to 2026 for each state and use the PI+ model to project the effects on states’ employment and economies.

Findings and Conclusions: While the draft BCRA and the AHCA would have similar effects on the number of uninsured Americans, the BCRA would lead to significantly larger job losses and deeper reductions in states’ economies by 2026. A brief spurt in employment would add 753,000 more jobs in 2018, but employment would then deteriorate sharply. By 2026, 1.45 million fewer jobs would exist, compared to levels under the current law. Every state except Hawaii would have fewer jobs and a weaker economy. Employment in health care would be especially hard hit with 919,000 fewer health jobs, but other employment sectors lose jobs too. Gross state products would be $162 billion lower in 2026. States that expanded Medicaid would be especially hard hit.

]]>42711The Health Care Job Engine: Where Do They Come From and What Do They Say About Our Future?http://www.afscmeinfocenter.org/blog/2017/07/health-care-job-engine-come-say-future.htm
Wed, 19 Jul 2017 17:26:16 +0000http://www.afscmeinfocenter.org/?p=42667Source: Bianca K. Frogner, Medical Care Research and Review, OnlineFirst, First Published January 19, 2017 (subscription required) From the abstract: Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has […]

From the abstract:
Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels. This study also found that the number of workers staying in health care has been slowly declining over time. As the United States moves toward team-based care, more attention should be paid to the needs of the lower skilled workers to reduce turnover and ensure delivery of quality care.

]]>42667‘Giving Help and Not Asking for It’: Inside the Mental Health of First Respondershttp://www.afscmeinfocenter.org/blog/2017/07/giving-help-and-not-asking-for-it-inside-the-mental-health-of-first-responders.htm
Fri, 07 Jul 2017 16:29:10 +0000http://www.afscmeinfocenter.org/?p=42577Source: Katherine Barrett & Richard Greene, Governing, July 7, 2017 Teaching cops, firefighters and prison workers to recognize and know how to handle people with mental illness is a big part of the efforts to reduce suffering and death at the hands of law enforcement. Less talked about is the mental health of the cops, […]

Teaching cops, firefighters and prison workers to recognize and know how to handle people with mental illness is a big part of the efforts to reduce suffering and death at the hands of law enforcement. Less talked about is the mental health of the cops, firefighters and prison workers themselves. ….

]]>42577Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needshttp://www.afscmeinfocenter.org/blog/2017/06/physician-workforce-locations-and-types-of-graduate-training-were-largely-unchanged-and-federal-efforts-may-not-be-sufficient-to-meet-needs.htm
Fri, 30 Jun 2017 15:02:28 +0000http://www.afscmeinfocenter.org/?p=42537Source: U.S. Government Accountability Office (GAO), GAO-17-411: Published: May 25, 2017 From the summary: The federal government has reported physician shortages in rural areas; it also projects a deficit of over 20,000 primary care physicians by 2025. Residents in graduate medical education (GME) affect the supply of physicians. Federal GME spending is over $15 billion/year. […]

From the summary:
The federal government has reported physician shortages in rural areas; it also projects a deficit of over 20,000 primary care physicians by 2025. Residents in graduate medical education (GME) affect the supply of physicians. Federal GME spending is over $15 billion/year.

We found that, from 2005-15, residents were concentrated in the Northeast and in urban areas. And, while many trained in primary care, primary care residents often subspecialize in other fields. Federal efforts to increase GME in rural areas and primary care were limited. In 2015, we recommended HHS develop a plan for its health care workforce programs—it has yet to do so.

]]>42537Implementation of a resident handling programme and low back pain in elder care workershttp://www.afscmeinfocenter.org/blog/2017/05/implementation-of-a-resident-handling-programme-and-low-back-pain-in-elder-care-workers.htm
Tue, 23 May 2017 19:22:47 +0000http://www.afscmeinfocenter.org/?p=42284Source: Andreas Holtermann, Occupational & Environmental Medicine, Volume 74, Issue 6, 2016 (subscription required) From the introduction: Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have […]

From the introduction:
Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have particularly high prevalence of LBP, and a considerable fraction of the LBP is considered to be caused by work-related factors. Moreover, LBP is a particular barrier for sustainable employment among workers with physically demanding work. Therefore, implementation of equipment (mechanical lifts or other assistive devices) for reducing the mechanical loading of healthcare workers during manual handling of residents should theoretically be efficient for preventing LBP and sickness absence among those with LBP. However, interventions implementing equipment for reducing the mechanical loading on healthcare workers during manual handling of residents show conflicting results on LBP. This might be due to the relatively short follow-up period of previous intervention studies introducing equipment for manual handling, which may need longer time before being fully implemented in an organisation. Moreover, it can be caused by lacking repetitive measures of both the implementation of the intervention as well as the often fluctuating level of LBP. Thus, there is a research gap in the documentation of the effects on LBP

From the abstract:
OBJECTIVES
A peer-support program called Resilience In Stressful Events (RISE) was designed to help hospital staff cope with stressful patient-related events. The aim of this study was to evaluate the impact of the RISE program by conducting an economic evaluation of its cost benefit.

METHODS
A Markov model with a 1-year time horizon was developed to compare the cost benefit with and without the RISE program from a provider (hospital) perspective. Nursing staff who used the RISE program between 2015 and 2016 at a 1000-bed, private hospital in the United States were included in the analysis. The cost of running the RISE program, nurse turnover, and nurse time off were modeled. Data on costs were obtained from literature review and hospital data. Probabilities of quitting or taking time off with or without the RISE program were estimated using survey data. Net monetary benefit (NMB) and budget impact of having the RISE program were computed to determine cost benefit to the hospital.

RESULTS
Expected model results of the RISE program found a net monetary benefit savings of US $22,576.05 per nurse who initiated a RISE call. These savings were determined to be 99.9% consistent on the basis of a probabilistic sensitivity analysis. The budget impact analysis revealed that a hospital could save US $1.81 million each year because of the RISE program.

CONCLUSIONS
The RISE program resulted in substantial cost savings to the hospital. Hospitals should be encouraged by these findings to implement institution-wide support programs for medical staff, based on a high demand for this type of service and the potential for cost savings.

]]>42267Philadelphia Union Wins Equal Pay for Immigrant Nurseshttp://www.afscmeinfocenter.org/blog/2017/05/philadelphia-union-wins-equal-pay-for-immigrant-nurses.htm
Mon, 08 May 2017 17:28:59 +0000http://www.afscmeinfocenter.org/?p=42129Source: Samantha Winslow, Labor Notes, May 5, 2017 It started when a few nurses at Temple University Hospital told stewards that they weren’t being paid for their experience. One of the first to speak up was Jessy Palathinkal, who had become a nurse in India in 1990. She got her U.S. nursing license when she […]

It started when a few nurses at Temple University Hospital told stewards that they weren’t being paid for their experience.

One of the first to speak up was Jessy Palathinkal, who had become a nurse in India in 1990. She got her U.S. nursing license when she moved here in 1995. But when she started working at Temple, her placement on the pay scale was as though those five years of nursing never happened.

She asked why. Human Resources told her the hospital didn’t count years of experience in foreign countries.

“I was feeling a little bit upset. I had all the certification,” Palathinkal said. “I thought, ‘Well, that’s not right, but what can I do?’”

What Palathinkal did was tell her shop steward. The steward told officers of their union, the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP). And the officers started asking around to see whether anyone else was affected.

They put out a call in their monthly newsletter—did anyone else think that their pay was incorrect for their level of experience? Three more nurses had the same complaint.

Four nurses joined a class-action grievance. Management denied it. That’s when union officers decided this was a hospital-wide issue…..

]]>42129Hospitals turn to job cuts amid budgetary woeshttp://www.afscmeinfocenter.org/blog/2017/05/hospitals-turn-to-job-cuts-amid-budgetary-woes.htm
Tue, 02 May 2017 14:58:36 +0000http://www.afscmeinfocenter.org/?p=42080Source: Paige Minemyer, Fierce Healthcare, May 1, 2017 Squeezed budgets and regulatory uncertainty are pushing a number of hospitals across the country to cut back on staff. One of the largest reductions in staff is taking place at Brigham and Women’s Hospital in Boston, which last week announced plans to offer buyouts to 1,600 employees. […]

Squeezed budgets and regulatory uncertainty are pushing a number of hospitals across the country to cut back on staff.

One of the largest reductions in staff is taking place at Brigham and Women’s Hospital in Boston, which last week announced plans to offer buyouts to 1,600 employees. The reason for the trouble: flat reimbursement and rising operating costs.

And it’s a problem felt across the country, STAT reports. Financial woes have already led Catholic Health Initiatives to slash 900 positions through layoffs and buyouts, STAT reports, and The University of Texas MD Anderson Cancer Care Center to cut 1,000 jobs.

In recent weeks layoffs have been announced at organizations in New York City, California, Minnesota and Rhode Island:
• Organizational restructuring” at NYC Health + Hospitals could lead to the loss of more than 600 jobs across the system’s 11 acute care facilities, according to a report from the New York Post.
• Hennepin County Medical Center in Minneapolis will cut 130 positions, or 2% of its full time staff, according to the STAT article.
• Riverside Community Hospital in California will layoff 42 employees amid a $400 million expansion, the Press-Enterprise reports. In addition to the job cuts, Riverside will close its cardiac rehab center and its ambulatory services unit.
• Care New England Health System, the second largest health system in Rhode Island, which recently announced a merger with Partners HealthCare, revealed that it will begin a “wide array” of layoffs at its flagship hospital, Women and Infants Hospital, reports the the Providence Journal. Though leaders at the facility would not confirm how many layoffs were planned, they said that both clinical and non-clinical positions would be affected…..

From the abstract:
This study examines the impact of hospitals on local labor markets in rural and urban counties. We measure the ability of hospitals, particularly in rural communities, to attract nonhealth-related employment and provide higher wage jobs to residents based on their education level. Results find hospital employees with an associate’s degree can expect a 21.4% wage premium, when compared with alternative opportunities, and those with a bachelor’s degree can earn 12.2% more working in a hospital. Hospitals are shown to be positively related to overall employment as well as exhibit positive employment spillover. For rural counties, a short-term general hospital is associated with 559 jobs in the county, 60 of which are hospital based and 499 are non–health care related. With the positive benefits on wages and non–health care job growth, hospitals have measurable positive labor market outcomes above their primary objective of providing health care access, particularly in rural counties.

]]>42033Health Care Workers Bring Sanctuary Movement into the Unionhttp://www.afscmeinfocenter.org/blog/2017/04/health-care-workers-bring-sanctuary-movement-into-the-union.htm
Mon, 17 Apr 2017 20:51:59 +0000http://www.afscmeinfocenter.org/?p=41945Source: Porfirio Quintano, Labor Notes, April 13, 2017 I had no money and spoke no English when I illegally crossed the border into California 23 years ago, but I worked hard and fought for the right to stay here. Had I made that harrowing journey this year, I’m sure I’d be deported right back into […]

I had no money and spoke no English when I illegally crossed the border into California 23 years ago, but I worked hard and fought for the right to stay here.

Had I made that harrowing journey this year, I’m sure I’d be deported right back into the crosshairs of the Honduran government’s death squads that had targeted me and many other community organizers.

Instead I quickly won a grant of political asylum—and later received full American citizenship.

I know I’m one of the lucky ones. At the San Francisco hospital where I work, nine out of 10 members of my union are foreign-born. We never ask anyone about their immigration status, but I know several green card holders who are getting ready to apply for citizenship now that their place in America seems less secure.

People might think the Bay Area is one big protective cocoon for immigrants, but that’s not the case. The suburb where I live is not a sanctuary city. And my elected county sheriff contracts with the Department of Homeland Security to house people awaiting deportation hearings.

Who can my co-workers count on if Immigration and Customs Enforcement (ICE) agents come looking for them or their family members? Our union, thankfully…..

]]>41945NHS research finds ‘direct link’ between staffing levels and death riskhttp://www.afscmeinfocenter.org/blog/2017/04/nhs-research-finds-direct-link-between-staffing-levels-and-death-risk.htm
Thu, 13 Apr 2017 15:12:54 +0000http://www.afscmeinfocenter.org/?p=41939Source: Shaun Lintern, HSJ, April 13, 2017 (subscription required) ….The project looked at staffing levels across 32 general medical and surgical wards at one NHS hospital between April 2012 and March 2015. More than 107,000 patients and almost 700,000 staff shifts were analysed using data from rostering systems and electronic observations, with the number of […]

….The project looked at staffing levels across 32 general medical and surgical wards at one NHS hospital between April 2012 and March 2015. More than 107,000 patients and almost 700,000 staff shifts were analysed using data from rostering systems and electronic observations, with the number of care hours per patient per day calculated and compared to mortality risks.

Key findings from the research were:
– When patients were exposed to low nursing hours during the first five days of their hospital stay, their risk of death significantly increased.
– For each day of low registered nurse staffing, the risk of death was increased by 3 per cent.
– Patients whose stay included days of high patient turnover in terms of admissions per nurse were associated with a 5 per cent increase in the risk of death.
– High levels of temporary staffing on the ward was associated with increased risk of death.
– When 1.5 or more nurse hours per patient day were provided by temporary staff the risk of death increased by 12 per cent.
– Each additional nurse hour per patient day was associated with a 2 per cent decrease in the chance of vital sign observations being missed…..

From the abstract:
Objective: With increasing emphasis on early and frequent mobilisation of patients in acute care, safe patient handling and mobilisation practices need to be integrated into these quality initiatives. We completed a programme evaluation of a safe patient handling and mobilisation programme within the context of a hospital-wide patient care improvement initiative that utilised a systems approach and integrated safe patient equipment and practices into patient care plans.

Results: Safe and unsafe patient handling practice scales at the study hospital improved significantly (p<0.0001 and p=0.0031, respectively), with no differences observed at the comparison hospital. We observed significant decreases in recordable neck and shoulder (Relative Risk (RR)=0.68, 95% CI 0.46 to 1.00), lifting and exertion (RR=0.73, 95% CI 0.60 to 0.89) and pain and inflammation (RR=0.78, 95% CI 0.62 to 1.00) injury rates at the study hospital. Changes in rates at the comparison hospital were not statistically significant.
Conclusions: Within the context of a patient mobilisation initiative, a safe patient handling and mobilisation programme was associated with improved work practices and a reduction in recordable worker injuries. This study demonstrates the potential impact of utilising a systems approach based on recommended best practices, including integration of these practices into the patient's plan for care.

]]>41897Quelling a storm of violence in healthcare settingshttp://www.afscmeinfocenter.org/blog/2017/04/quelling-a-storm-of-violence-in-healthcare-settings.htm
Thu, 06 Apr 2017 21:42:52 +0000http://www.afscmeinfocenter.org/?p=41862Source: Elizabeth Whitman, Modern Healthcare, Vol. 47 no. 11, March 13, 2017 Violence in healthcare settings has risen steadily in recent years. That has taken a growing financial and human toll on the nation’s 15 million healthcare workers and on its hospitals and long-term care centers, and has prompted executives, providers and policymakers to take […]

Violence in healthcare settings has risen steadily in recent years. That has taken a growing financial and human toll on the nation’s 15 million healthcare workers and on its hospitals and long-term care centers, and has prompted executives, providers and policymakers to take action in myriad ways.

]]>41862The Impact of the Affordable Care Act on Health Coverage for Direct Care Workerhttp://www.afscmeinfocenter.org/blog/2017/03/the-impact-of-the-affordable-care-act-on-health-coverage-for-direct-care-worker.htm
Mon, 20 Mar 2017 18:16:03 +0000http://www.afscmeinfocenter.org/?p=41780Source: Stephen Campbell, PHI, Issue Brief, March 2017 From the summary: Direct care workers—nursing assistants, home health aides, and personal care aides who support older Americans and people with disabilities—are among America’s lowest paid workers, often struggling to access health coverage. However, new coverage numbers show that this workforce benefited substantially from the Affordable Care […]

From the summary:
Direct care workers—nursing assistants, home health aides, and personal care aides who support older Americans and people with disabilities—are among America’s lowest paid workers, often struggling to access health coverage. However, new coverage numbers show that this workforce benefited substantially from the Affordable Care Act (ACA). Between 2010 and 2014, half a million direct care workers gained coverage. At the same time, the uninsured rate across this workforce decreased by 26 percent. As the Trump administration and the new Congress consider the future of the Affordable Care Act (ACA) and Medicaid, it is important to consider the impact of these changes on this critical U.S. workforce.

]]>41780No Difference in Patient Mortality in Medical ICUs Staffed by NPs vs Residentshttp://www.afscmeinfocenter.org/blog/2017/03/no-difference-in-patient-mortality-in-medical-icus-staffed-by-nps-vs-residents.htm
Mon, 13 Mar 2017 21:01:57 +0000http://www.afscmeinfocenter.org/?p=41737Source: Karen Rosenberg, Joan Zolot, AJN, American Journal of Nursing, Volume 117 – Issue 3, March 2017 (subscription required) From the abstract: According to this study: * No differences were found in mortality rates or costs between a medical ICU staffed by NPs and one staffed by residents, although patients on the NP-staffed unit had […]

From the abstract:
According to this study:
* No differences were found in mortality rates or costs between a medical ICU staffed by NPs and one staffed by residents, although patients on the NP-staffed unit had longer lengths of stay.
* NPs provide safe, competent care to patients in the medical ICU, offering an alternative to care provided by residents and interns.

From the abstract:
Pulmonary tuberculosis (TB) infection remains an occupational health burden among healthcare workers (HCWs), but current surveillance data do not allow for attribution of pulmonary TB disease to occupational or community exposures. The objectives of this study were to estimate the annual number of occupationally acquired pulmonary TB infections among HCW in acute care settings (ambulatory care, emergency departments (EDs), and hospitals) in the USA, and to estimate the impact of increased compliance with respiratory protection. We used a risk analysis approach, in which occupational exposures were modeled using a compartmental model of bacilli transport and fate, and infection risk was estimated using two dose–response (DR) functions. With the conservative Wells–Riley DR function, we estimated 6420 occupationally acquired pulmonary TB infections annually in the USA, on average; with the more likely animal-based DR function, we estimated 3288 occupationally acquired pulmonary TB infections annually in the USA, on average. Increased (95%) compliance with respiratory protection would eliminate about one-third of pulmonary TB infections. Using results from the animal-based DR function, we estimated 82 cases of pulmonary TB disease will develop among US workers annually, on average, given 50% of infected HCW receive effective chemoprohylaxis and 5% of infections progress to disease. These results are consistent with national surveillance of pulmonary TB disease, and provide confidence that the analytical framework provides plausible results.

From the abstract:
Objective: This study evaluated the cardiometabolic, behavioral, and psychosocial factors associated with weight status among hospital employees.

Methods: A total of n = 924 employees across the six hospitals in Texas participated in this cross-sectional study, 2012 to 2013. Association between weight status and waist circumference, blood pressure, biomarkers, diet, physical activity, sedentary behaviors, and psychosocial factors was assessed.

Results: About 78.1% of employees were overweight/obese. Obese participants (body mass index [BMI] ≥30.0 kg/m2) had higher consumption of potatoes, fats, sugary beverages, and spent more time watching television, playing computer games, and sitting than those having normal weight. Being obese was positively associated with blood pressure, blood glucose, low-density lipoprotein, and negatively associated with high-density lipoprotein. Finally, 78.8% of workers were dissatisfied with their worksite wellness with dissatisfaction being higher among obese employees. Being overweight (BMI 25.0 to 29.9 kg/m2) was positively associated with blood pressure, but not other variables.

]]>4165360 Caregiver Issueshttp://www.afscmeinfocenter.org/blog/2017/02/60-caregiver-issues.htm
Tue, 07 Feb 2017 22:05:43 +0000http://www.afscmeinfocenter.org/?p=41561Source: PHI, 2017 In 2017, PHI began identifying the most pressing policy issues facing direct care workers. Our research, unique industry expertise, and partnerships with state and national leaders aptly position us to address a worsening concern: direct care workers are walking away from this sector at a time when we need critical supports to […]

In 2017, PHI began identifying the most pressing policy issues facing direct care workers. Our research, unique industry expertise, and partnerships with state and national leaders aptly position us to address a worsening concern: direct care workers are walking away from this sector at a time when we need critical supports to age in our homes and communities. In turn, families and the agencies that serve them are left with few options.

Recognizing a growing workforce shortage among our nation’s home care aides, nursing aides, and personal care aides, as well as the need to provide quality care to a rapidly growing population of older people and people with disabilities, PHI launched a national campaign: 60 Caregiver Issues.

Over the course of two years, PHI will release a new issue every 2-3 weeks, inspiring policy makers and long-term care leaders to pinpoint what needs to be done to remedy this shortage and create a vibrant, sustainable system of long-term care.

]]>41561Repealing the Affordable Care Act would cost jobs in every statehttp://www.afscmeinfocenter.org/blog/2017/01/repealing-the-affordable-care-act-would-cost-jobs-in-every-state.htm
Tue, 31 Jan 2017 22:53:08 +0000http://www.afscmeinfocenter.org/?p=41533Source: Josh Bivens, Economic Policy Institute, January 31, 2017 From the press release: A new report by EPI Research Director Josh Bivens finds that repealing the Affordable Care Act (ACA) will cost the economy 1.2 million jobs in 2019, with jobs lost in every state. The report looks at the effects of cuts to both […]

From the press release:
A new report by EPI Research Director Josh Bivens finds that repealing the Affordable Care Act (ACA) will cost the economy 1.2 million jobs in 2019, with jobs lost in every state. The report looks at the effects of cuts to both spending and taxes that would occur under a full repeal.

The $109 billion in spending cuts would have a disproportionally negative effect on states with the highest share of low and middle-income families and those states that took up the ACA Medicaid expansion, while the $70 billion tax cuts would disproportionately benefit those states with the largest share of households in the top 1 percent. Because low- and moderate-income households tend to spend a much higher share of marginal increases in disposable income, the overall effect of ACA repeal would be less spending and slower demand growth across all states…..
Related:
Summary

From the abstract:
Purpose of the Study: This study examined how certified nursing assistants (CNAs) with unpaid family caregiving roles for children (“double-duty-child caregivers”), older adults (“double-duty-elder caregivers”), and both children and older adults (“triple-duty caregivers”) differed from their nonfamily caregiving counterparts (“workplace-only caregivers”) on four work strain indicators (emotional exhaustion, job satisfaction, turnover intentions, and work climate for family sacrifices). The moderating effects of perceived family time adequacy were also evaluated.

Design and Methods: Regression analyses were conducted on survey data from 972 CNAs working in U.S.-based nursing homes.

Results: Compared with workplace-only caregivers, double-and-triple-duty caregivers reported more emotional exhaustion and pressure to make family sacrifices for the sake of work. Triple-duty caregivers also reported less job satisfaction. Perceived family time adequacy buffered double-duty-child and triple-duty caregivers’ emotional exhaustion and turnover intentions, as well as reversed triple-duty caregivers’ negative perceptions of the work climate.

Implications: Perceived family time adequacy constitutes a salient psychological resource for double-duty-child and triple-duty caregivers’ family time squeezes. Amid an unprecedented demand for long-term care and severe direct-care workforce shortages, future research on workplace factors that increase double-and-triple-duty caregiving CNAs’ perceived family time adequacy is warranted to inform long-term care organizations’ development of targeted recruitment, retention, and engagement strategies.

]]>41450Hospital-Acquired Infections: Stop Preventable Deathshttp://www.afscmeinfocenter.org/blog/2017/01/hospital-acquired-infections-stop-preventable-deaths.htm
Wed, 11 Jan 2017 22:00:00 +0000http://www.afscmeinfocenter.org/?p=41439Source: Ontario Council of Hospital Unions and Canadian Union of Public Employees (CUPE), 2017 From the summary: With provincial funding for Ontario hospital services falling for years, understaffing is getting worse in hospital environmental services, with reports of layoffs and cuts occurring regularly, a survey of front line cleaning staff has found. Concerns are growing […]

From the summary:
With provincial funding for Ontario hospital services falling for years, understaffing is getting worse in hospital environmental services, with reports of layoffs and cuts occurring regularly, a survey of front line cleaning staff has found. Concerns are growing among environmental service workers that Ontario hospitals do not have the capacity and enough cleaning staff to keep bedrails, mattresses, taps, door handles and chairs sterilized and bacteria free.

In the fall of 2016, the CUPE completed a survey of 421 hospital housekeeping staff from over 60 hospitals right across Ontario. Hospital-Acquired Infections: Stop Preventable Deaths, that melds the survey findings with recent public health agency and other research reports, was released in Cornwall today.

The survey revealed a disturbing pattern of speed up, working short, high levels of stress and injury at work. A large majority (78 per cent) report that more duties have been added to their work. Accordingly, a large majority (76 per cent) report working at a faster rate. Over half believe the situation is unsafe. As well, 40 per cent of hospital locals report that hospital environmental service hours have been cut, in the last year alone.

Seventy per cent of housekeeping staff also report working short. This occurs when staff who are off of work for vacation, sick leave, training, or other reasons are not replaced.

Infection can easily spread from patient to patient through personal touch or by touching contaminated shared surfaces. “There just aren’t enough cleaning staff to properly clean patient rooms, bathrooms and common areas to prevent infection. Because we are often working short, we are given additional duties and workloads for cleaning staff are enormous. Increasing staffing levels would go a long way to ensuring a safer environment for patients/clients, families, staff, physicians and volunteers,” says Nicholas Black a hospital cleaner.

The Public Health Agency of Canada reports that more than 200,000 patients get infections every year while receiving healthcare in Canada and that more than 8,000 of these patients, more than 3,000 of them Ontario patients, die as a result.

]]>41439Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homeshttp://www.afscmeinfocenter.org/blog/2017/01/who-hires-social-workers-structural-and-contextual-determinants-of-social-service-staffing-in-nursing-homes.htm
Tue, 03 Jan 2017 17:13:23 +0000http://www.afscmeinfocenter.org/?p=41401Source: Amy Restorick Roberts and John R. Bowblis, Health & Social Work, Advance Access, First published online: December 7, 2016 (subscription required) From the abstract: Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines […]

From the abstract:
Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009–2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed.

Design and Methods: A sample of 884 CNAs from the Work, Family and Health Study was drawn on to assess the number of acute care (i.e., emergency room or urgent care facility) and other health care (i.e., outpatient treatment or counseling) visits made during the past 6 months.

Results: Double-duty elder and triple-duty caregivers had higher acute care utilization rates than formal-only caregivers. CNAs with and without family caregiving roles had similar rates of other health care visits.

Implications: CNAs providing informal care for older adults have higher acute care visit rates. Given the increasing need for family caregivers and the vital importance of the health of the nursing workforce for the health of others, future research on how double- and triple-duty caregivers maintain their health amidst constant caregiving should be a priority.

From the abstract:
This paper examines the relationship between labor–management partnership (LMP) and employee voice in the healthcare setting. We argue that the ability of LMP to deliver gains to employees is contingent on the quality of the procedural infrastructure on which it is established. We maintain that the quality of LMP processes influences employee trust in their employer and perceptions of union effectiveness and that these perceptions, in turn, are related to employee patient‐care voice.

From the abstract:
Background: Environmental contamination has been associated with over half of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in hospitals. We explored if a hospital-wide environmental and patient cleaning protocol would lower hospital acquired MRSA rates and associated costs.

Objective: This study evaluates the impact of implementing a hospital-wide environmental and patient cleaning protocol on the rate of MRSA infection and the potential cost benefit of the intervention.

Methods: A retrospective, pre-post interventional study design was used. The intervention comprised a combination of enhanced environmental cleaning of high touch surfaces, daily washing of patients with benzalkonium chloride, and targeted isolation of patients with active infection. The rate of MRSA infection per 1000 patient days (PD) was compared with the rate after the intervention (Steiros Algorithm®) was implemented. A cost–benefit analysis based on the number of MRSA infections avoided was conducted.

Results: The MRSA rates decreased by 96% from 3.04 per 1000 PD to 0.11 per 1000 PD (P <0.0001). This reduction in MRSA infections, avoided an estimated $1,655,143 in healthcare costs.
Discussion: Implementation of this hospital-wide protocol appears to be associated with a reduction in the rate of MRSA infection and therefore a reduction in associated healthcare costs.

From the abstract:
Objective: To describe the use of mandated safety engineered sharps devices (SESDs) and personal protective equipment in healthcare workers (HCWs) with occupational body fluid exposures (BFE) since the Needlestick Safety and Prevention Act.

Methods: Two questionnaires were administered, over 3 years, to HCWs who reported sharps or splash BFEs. Descriptive statistics and chi-square analysis were used.

Results: Of the 498 questionnaires completed, nurses completed 262 (53%), house staff 155 (32 %), technicians 63 (13%) and phlebotomists 11 (2%). Four (1%) completers reported ‘other’ and three (1%) reported unknown. Sharps injuries accounted for 349 (70%) of the BFEs. SESDs were utilised 43% (128/299) of the time with a 54% (70/130) activation rate. Phlebotomists (80%; 8/10) and nurses (59%; 79/267) used SESDs more than doctors (27%; 31/86) and technicians (26%; 10/39) (P <0.0001). Fifty-four percent (185/207) of HCWs reported having had training on SESD use; nurses (64%; 98/154) and phlebotomists (70%; 7/8) significantly more so than house staff (44%; 59/133) and technicians (44%; 21/48) (P <0.05). Most splash BFEs were to the eyes 73% (91/149). Five percent (4/79) of HCWs used protective eyewear.
Conclusions: Systematic regular training, appropriate protocols and iteratively providing the safest SESDs based on HCW experience and technological advances will further reduce the physical and emotional toll of BFEs.

]]>41142Buffalo Hospital Workers Get Their Money and Staffing Backhttp://www.afscmeinfocenter.org/blog/2016/12/buffalo-hospital-workers-get-their-money-and-staffing-back.htm
Fri, 02 Dec 2016 19:07:12 +0000http://www.afscmeinfocenter.org/?p=41129Source: Patrick Weisansal and Ann Converso, Labor Notes, November 29, 2016 After giving something up in a previous contract, is it possible to win it back? It took a massive effort, but hospital workers in Buffalo proved it can be done. Catholic Health is one of the two local hospital chains that dominate western New […]

After giving something up in a previous contract, is it possible to win it back? It took a massive effort, but hospital workers in Buffalo proved it can be done.

Catholic Health is one of the two local hospital chains that dominate western New York. Communications Workers (CWA) Locals 1133 and 1168 represent 6,900 of its employees in six bargaining units.

Four years ago, Catholic Health cried poverty at the bargaining table. Threatened with layoffs, our unions reluctantly agreed to eliminate daily overtime (after eight or 12 hours, depending on the job—of particular importance to part-timers), cost-of-living increases, bonus pay for nurses who came in on short notice, and seniority-based wage scales. ….

From the abstract:
Over the past ten years, many healthcare organizations have made significant investments in automating their clinical operations, mostly through the introduction of advanced information systems. Yet the impact of these investments on staffing is still not well understood. In this paper, we study the effect of IT-enabled automation on staffing decisions in healthcare facilities. Using unique nursing home IT data from 2006 to 2012, we find that the licensed nurse staffing level decreases by 5.8% in high-end nursing homes but increases by 7.6% in low-end homes after the adoption of automation technology. Our research explains this by analyzing the interplay of two competing effects of automation: the substitution of technology for labor and the leveraging of complementarity between technology and labor. We also find that increased automation improves the ratings on clinical quality by 6.9% and decreases admissions of less profitable residents by 14.7% on average. These observations are consistent with the predictions of an analytical staffing model that incorporates technology adoption and vertical differentiation. Overall, these findings suggest that the impact of automation technology on staffing decisions depends crucially on a facility’s vertical position in the local marketplace.

From the abstract:
Background: Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region.

Methods: Disinfectant use was assessed by questionnaire in 8,851 nurses. Hospital characteristics were obtained from the American Hospital Association database.

Results: Working in a hospital was associated with higher disinfectant use (OR: 2.06 [95%CI: 1.89–2.24]), but lower spray use (0.74 [0.66–0.82]). Nurses working in smaller hospitals (<50 beds vs. ≥200 beds) were more likely to use disinfectants (1.69 [1.23–2.32]) and sprays (1.69 [1.20–2.38]). Spray use was lower in the West than in the Northeast (0.75 [0.58–0.97]).
Conclusion: Disinfectant use was more common among nurses working in smaller hospitals, possibly because they perform more diverse tasks. Variations in spray use by hospital size and region suggest additional targets for future efforts to prevent occupational asthma.

From the abstract:
Objective: With increasing emphasis on early and frequent mobilisation of patients in acute care, safe patient handling and mobilisation practices need to be integrated into these quality initiatives. We completed a programme evaluation of a safe patient handling and mobilisation programme within the context of a hospital-wide patient care improvement initiative that utilised a systems approach and integrated safe patient equipment and practices into patient care plans.

Results: Safe and unsafe patient handling practice scales at the study hospital improved significantly (p<0.0001 and p=0.0031, respectively), with no differences observed at the comparison hospital. We observed significant decreases in recordable neck and shoulder (Relative Risk (RR)=0.68, 95% CI 0.46 to 1.00), lifting and exertion (RR=0.73, 95% CI 0.60 to 0.89) and pain and inflammation (RR=0.78, 95% CI 0.62 to 1.00) injury rates at the study hospital. Changes in rates at the comparison hospital were not statistically significant.
Conclusions: Within the context of a patient mobilisation initiative, a safe patient handling and mobilisation programme was associated with improved work practices and a reduction in recordable worker injuries. This study demonstrates the potential impact of utilising a systems approach based on recommended best practices, including integration of these practices into the patient's plan for care.

From the abstract:
This article reviewed a program evaluation conducted among correctional health care staff in New York City (NYC) using a 68-question electronic survey to assess satisfaction, attitudes, and beliefs in relation to ethics and burnout of health care employees in NYC jails. Descriptive statistics were tabulated and reviewed, and further assessment of burnout and ethics was performed through group sessions with participants. This evaluation has led to changes in agency policies and procedures and an emphasis on the human rights issue of the dual loyalty challenges that the security setting places on the overall mission to care for patients.

For too long, health care workers have suffered from the assumption that workplace violence is just part of the job. But that’s finally changing—and union nurses are playing a key role in propelling the change forward.

Members of the Massachusetts Nurses are proud that their efforts were recently touted among the nation’s best practices. In a “Road Map” report on how to address violence in health care facilities, the Occupational Health and Safety Administration (OSHA) features contract language that MNA nurses negotiated at two Western Massachusetts hospitals.

OSHA credits “the joint efforts of labor and management” for the results—fewer and less severe patient assaults on health care workers….

From the abstract:
Background: Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies.
Methods: Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals.
Results: Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients’ medical records—with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own “threshold” of when to report based on event circumstances.
Conclusions: Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers’ reports, including the use of a designated violence reporting system that is supported by reporting policies.

]]>40665An Excel Spreadsheet Model for States and Districts to Assess the Cost-Benefit of School Nursing Serviceshttp://www.afscmeinfocenter.org/blog/2016/10/an-excel-spreadsheet-model-for-states-and-districts-to-assess-the-cost-benefit-of-school-nursing-services.htm
Tue, 04 Oct 2016 17:29:38 +0000http://www.afscmeinfocenter.org/?p=40656Source: Li Yan Wang, Mary Jane O’Brien, Erin Maughan, NASN School Nurse, Published online before print September 13, 2016 (subscription required) from the abstract: This paper describes a user-friendly, Excel spreadsheet model and two data collection instruments constructed by the authors to help states and districts perform cost-benefit analyses of school nursing services delivered by […]

from the abstract:
This paper describes a user-friendly, Excel spreadsheet model and two data collection instruments constructed by the authors to help states and districts perform cost-benefit analyses of school nursing services delivered by full-time school nurses. Prior to applying the model, states or districts need to collect data using two forms: “Daily Nurse Data Collection Form” and the “Teacher Survey.” The former is used to record daily nursing activities, including number of student health encounters, number of medications administered, number of student early dismissals, and number of medical procedures performed. The latter is used to obtain estimates for the time teachers spend addressing student health issues. Once inputs are entered in the model, outputs are automatically calculated, including program costs, total benefits, net benefits, and benefit-cost ratio. The spreadsheet model, data collection tools, and instructions are available at the NASN website.

From the abstract:
The use of agency nurses offers flexibility in filling registered nurse (RN) openings during times of shortage, yet little is known about their use in specialized palliative care. In an effort to fill this knowledge gap, this study determined whether significant relationships existed between full-time and part-time RN vacancies and the use of agency RNs within specialized hospices that deliver perinatal end-of-life care to women and their families in the event of miscarriage, ectopic pregnancy, or other neonatal complications resulting in death. This study used data from the 2007 National Home and Hospice Care Survey and multivariate regression methods to estimate the association between RN vacancies and agency RNs use. Approximately 13% of perinatal hospices in 2007 used agency nurses. Increases in full-time RN vacancies are associated with a significant increase in the use of agency RNs, while part-time RN vacancies are associated with a significant decrease in agency RNs. These results suggest that full-time agency RNs were used as a supplemental workforce to fill vacancies until the full-time position is recruited. However, for part-time vacancies, the responsibilities of those positions shifted onto existing staff and the position was not filled.

From the summary:
Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide long-term services and supports (LTSS), but limitations and gaps affect the data’s usefulness for workforce planning. Some states have collected data in areas where federal data are limited, but these have been one-time studies. Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation’s health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing. Some states, in coordination with the federal government or on their own, have conducted studies about direct care workers and collected detailed information. These studies showed that a majority of independent providers worked for a family member or someone else they knew.

]]>40587A Healthcare Employer Guide to Hiring People with Arrest and Conviction Records: Seizing the Opportunity to Tap a Large, Diverse Workforcehttp://www.afscmeinfocenter.org/blog/2016/09/a-healthcare-employer-guide-to-hiring-people-with-arrest-and-conviction-records-seizing-the-opportunity-to-tap-a-large-diverse-workforce.htm
Tue, 20 Sep 2016 16:09:16 +0000http://www.afscmeinfocenter.org/?p=41986Source: Sodiqa Williams, Safer Foundation and National Employment Law Project (NELP), September 2016 ….As the healthcare industry continues to grow, employers have an opportunity to launch innovative workforce development strategies to assure a diversified pipeline of qualified healthcare workers. Businesses of all sizes and types come and go in the communities they serve. However, healthcare […]

….As the healthcare industry continues to grow, employers have an opportunity to launch innovative workforce development strategies to assure a diversified pipeline of qualified healthcare workers. Businesses of all sizes and types come and go in the communities they serve. However, healthcare organizations help keep many communities afloat and steady, even in hard financial and uncertain times. Adopting a hiring policy for people with records can help you achieve your business objectives while advancing your mission to serve the public. Consult this toolkit for guidance on implementing a hiring program for people with records. Several healthcare providers and trainers featured in the toolkit are at the forefront of a movement to invest in workforces in underserved communities. We can all learn from their experiences in developing policies and practices that work. With the guidance provided in the toolkit, you can be proactive in recruiting people with records from your community…..
Related:Ensuring People With Convictions Have a Fair Chance to Work
Source: National Employment Law Project (NELP)

An estimated 70 million people in the United States—nearly one in three adults—have a prior arrest or conviction record. A racially biased criminal justice system and mass incarceration have severely impacted communities of color. A conviction in one’s past shouldn’t be a life sentence to joblessness. NELP is working to expand fair-chance hiring laws to every corner of the nation, because everyone deserves an opportunity to work for a better life.

]]>41986Caregiving Crisis Highlighted in PHI Fact Sheetshttp://www.afscmeinfocenter.org/blog/2016/09/caregiving-crisis-highlighted-in-phi-fact-sheets.htm
Wed, 07 Sep 2016 13:52:08 +0000http://www.afscmeinfocenter.org/?p=40377Source: Paraprofessional Healthcare Institute (PHI), September 6, 2016 From the blog post: Two fact sheets from PHI highlight the low wages, high injury rates, and high demand that characterize nursing assistant and home care aide jobs, two occupations at the center of the U.S. caregiving crisis: – U.S. Home Care Workers: Key Facts – U.S. […]

Key Facts Among the findings:
– 633,000 additional home care workers are needed by 2024, more new jobs than any other occupation in the U.S. economy.
– Low wages, limited work hours, and low annual earnings cause one in four home care workers to live in poverty, compared to one in ten U.S. workers.
– This high poverty rate means one in two home care workers relies on some form of public assistance, such as food stamps, Medicaid, or cash assistance.
– Nursing assistants are more than three times as likely to be injured on the job than the average U.S. worker.
– Due primarily to poor job quality, 52 percent of nursing assistants leave their jobs each year, and 50,000 nursing assistant positions nationwide cannot be filled.
The fact sheets, which provide comprehensive analyses on workforce demographics, size and composition, job quality indicators, and employment projections, will be released on an annual basis.

]]>40377Put Workers Back at the Center of Organizinghttp://www.afscmeinfocenter.org/blog/2016/08/put-workers-back-at-the-center-of-organizing.htm
Wed, 31 Aug 2016 15:27:50 +0000http://www.afscmeinfocenter.org/?p=40326Source: Jane McAlevey, New Labor Forum, Vol. 25 no. 3, September 2016 (subscription required) ….Whether in eastern Pennsylvania, Chicago and Los Angeles (teachers), Boston (nurses), or Hartford (nursing home and other health care workers)—to name just a few—the hard work of whether unions shrink, expand, or are relevant to anyone (save the national leaders) is […]

….Whether in eastern Pennsylvania, Chicago and Los Angeles (teachers), Boston (nurses), or Hartford (nursing home and other health care workers)—to name just a few—the hard work of whether unions shrink, expand, or are relevant to anyone (save the national leaders) is determined more by what happens when one pissed-off non-union worker picks up the phone and cold calls a unionized worker asking, simply, “do you like your union?” And, “does your employer get away with anything they want or do you have the ability to stop bad management behavior?” If the answer is a resounding “yes, we’ve built a very powerful union and it’s great!”—there’s a very high likelihood that not-yet-union workers will be motivated to attempt the same. At Temple University Hospital, the nurses waged an all-out 28-day open-ended strike in 2010 and in so doing built one hell of a union and won one hell of a contract…..

]]>403262016 Healthcare Salary Guidehttp://www.afscmeinfocenter.org/blog/2016/08/2016-healthcare-salary-guide.htm
Fri, 19 Aug 2016 21:08:40 +0000http://www.afscmeinfocenter.org/?p=40227Source: Health eCareers, 2016 Our 2016 Salary Guide is a comprehensive look at healthcare compensation, benefits and more! Take a sneak peek, then download the full guide using the form below. Find out how your pay stacks up against other healthcare professionals when it comes to specialty, location and experience using our Salary Calculator, then […]

Our 2016 Salary Guide is a comprehensive look at healthcare compensation, benefits and more! Take a sneak peek, then download the full guide using the form below. Find out how your pay stacks up against other healthcare professionals when it comes to specialty, location and experience using our Salary Calculator, then download our annual Salary Guide for even more information, including salary and job satisfaction stats, benefits and employee concerns.

]]>40227Why the US now pulls fewer nurses from abroadhttp://www.afscmeinfocenter.org/blog/2016/08/why-the-us-now-pulls-fewer-nurses-from-abroad.htm
Tue, 16 Aug 2016 15:21:15 +0000http://www.afscmeinfocenter.org/?p=40175Source: Christopher James, Futurity, August 2, 2016 A study examining a decade’s worth of data on internationally educated nurses seeking work in the US reveals some striking data to counter the “brain drain” narrative. In what’s known as nursing “brain drain,” locally educated nurses would go to school but then seek employment in the US, […]

A study examining a decade’s worth of data on internationally educated nurses seeking work in the US reveals some striking data to counter the “brain drain” narrative.

In what’s known as nursing “brain drain,” locally educated nurses would go to school but then seek employment in the US, leaving their home country without adequate nursing talent and resources.

Historically, the United States has been a top receiving country of internationally educated nurses (IEN). These nurses had often worked in areas where there were significant nursing shortages. Because of this, the US has been seen internationally as a major global contributor to a phenomenon of talent emigration.

A total of 177 countries were eligible for inclusion in the study, representing findings from 200,453 IEN applicants to the US between 2003 and 2013. Their work found that changes to the NCLEX-RN licensure examination (2008), the global economic crisis of late 2008, and the passing of the World Health Organization’s Code for Ethical Recruitment of Health Workers (2010), all played a part in the significant drop in IEN applicants…..

No study has examined the longitudinal trends in National Council Licensure Exam for Registered Nurse (NCLEX-RN) applicants and pass rates among internationally-educated nurses (IENs) seeking to work in the United States, nor has any analysis explored the impact of specific events on these trends, including changes to the NCLEX-RN exam, the role of the economic crisis, or the passing of the WHO Code on the International Recruitment of Health Personnel. This study seeks to understand the impact of the three aforementioned factors that may be influencing current and future IEN recruitment patterns in the United States.

Methods:
In this random effects panel data analysis, we analyzed 11 years (2003–2013) of annual IEN applicant numbers and pass rates for registered nurse credentialing. Data were obtained from publicly available reports on exam pass rates. With the global economic crisis and NCLEX-RN changes in 2008 coupled with the WHO Code passage in 2010, we sought to compare if (1) the number of applicants changed significantly after those 2 years and (2) if pass rates changed following exam modifications implemented in 2008 and 2011.

Results:
A total of 177 countries were eligible for inclusion in this analysis, representing findings from 200,453 IEN applicants to the United States between 2003 and 2013. The majority of applicants were from the Philippines (58 %) and India (11 %), with these two countries combined representing 69 % of the total. Candidates from Sub-Saharan African countries totalled 7133 (3 % of all applications) over the study period, with half of these coming from Nigeria alone. No significant changes were found in the number of candidates following the 2008 economic crisis or the 2010 WHO Code, although pass rates decreased significantly following the 2008 exam modifications and the WHO Code implementation.

Conclusion:
This study suggests that, while the WHO Code has had an influence on overall IEN migration dynamics to the United States by decreasing candidate numbers, in most cases, the WHO Code was not the single cause of these fluctuations. Indeed, the impact of the NCLEX-RN exam changes appears to exert a larger influence.

From the abstract:
Purpose of the study: To (a) describe A Scheduled Shifts Staffing measure (ASSiST) to derive care aide worked hours per resident day (HCA WHRD) at facility and unit levels in nursing homes, (b) report reliability through comparisons to administrative staffing data; (c) report validity by examining associations between HCA WHRD, staff outcomes (job satisfaction, emotional exhaustion), and resident quality indicators (QIs) (e.g. falls, delirium, stage 2+ pressure ulcers), and (d) explore intrafacility variation in staffing intensity levels related to unit-level variation in resident and staff outcomes.
Design and Methods: We used data from 40 care units in 12 Canadian nursing homes between 2007 and 2012. Descriptive statistics and tests of association and difference described relationships of two measures of staffing with resident and staff outcomes.

Results: Annualized rates of HCA WHRD from both data sources compared well at the facility level, and were correlated similarly to staff work life and many QIs. Using ASSiST data, we show that staffing levels can vary by up to 40% at the unit-level within nursing homes.

Implications: ASSiST is easy to collect, more timely to retrieve than administrative data, has good criterion and construct validity, and reflects intrafacility variation in health care aide staffing levels.

From the abstract:
Purpose of the Study: To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes.

Design and Methods: Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status.

Results: A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes.

]]>40108Underpaid, unpaid, unseen, unheard and unhappy? Care work in the context of constrainthttp://www.afscmeinfocenter.org/blog/2016/08/underpaid-unpaid-unseen-unheard-and-unhappy-care-work-in-the-context-of-constraint.htm
Mon, 08 Aug 2016 15:10:21 +0000http://www.afscmeinfocenter.org/?p=40073Source: Donna Baines, Sara Charlesworth, Tamara Daly, Journal of Industrial Relations (JIR), Vol. 58 no. 4, September 2016 (subscription required) From the abstract: Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., […]

From the abstract:
Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., 2015). Due to its close association with gendered expectations of elastic, uncomplaining work undertaken by women across the continuum of home, community and residential places, care work continues to be undervalued in numerous ways (Baines, 2004; England, 2005; Folbre, 2008). Indeed, care workers often work in conditions in which they are underpaid, unpaid, unseen, unheard and unhappy (Daly and Szebehely, 2012; Palmer and Eveline, 2012). These conditions are related to government austerity models; how care work is regulated within employment relations; state, market and private roles providing and funding care; and how care work organisation is shifting in the context of austerity strategies, policies of constraint, continued high demand, decreased union density and increasing standardisation.

These conditions and the women who work within them and around them are the focus of this Special Issue: Care Work in the Context of Constraint. The Special Issue draws together international researchers and scholars in a close investigation of the complexity of care work in the era of austerity policies.
Government bodies that fund care work have been under increasing pressure to cut costs, expand accountability and contribute to austerity agendas (Brennan et al., 2012; Cunningham et al., 2014; Grimshaw and Rubery, 2012). This impacts at the level of care organisations in the form of decreased financial resources and increased obligations to provide documentary and statistical evidence of the care provided to service users…..

From the abstract:
Background: Needlestick injuries (NSIs) represent a major concern for the safety of health care workers involved in clinical care. The percentage of health workers reporting these injuries varies between 9 and 38% and the occurrence of NSI is most frequent among employees having close clinical contact with patients or patient specimens. These injuries appear to occur most frequently where organizational factors contribute to the risk.

Aims: To investigate the interactions between organizational level interventions focused on work-related stress (WRS) and the occurrence of NSIs among nurses employed in hospital departments, and to determine the impact of such interventions on the safety budget.

Methods Comparison of NSI occurrence among nurses employed in hospital health care departments in two 3-year periods, before and after interventions aimed at minimizing WRS. The economic cost of NSIs occurrence was calculated.

Results: The study group consisted of 765 nurses. The cumulative 3-year incidence of NSIs after the implementation of management stress interventions was significantly lower than the cumulative 3-year incidence observed before implementation (OR 0.60; 95% CI 0.43–0.83). A cost saving from managing fewer NSIs than during the first study period was found.

Conclusions: This study found a reduction in NSI occurrence and associated costs following an intervention to bring about proactive, integrated and comprehensive management of stress in the workplace.